October 28, 2018

Morphine Dependence

So, what is morphine? Morphine is a potent opiate analgesic that is clinically used to manage pain, mostly pain that occurs after surgery and for patients with terminal cancer. But morphine can also be prescribed for pain management on a short-term basis following significant injury or trauma. Morphine is a strong opiate, a highly addictive narcotic drug classified by the Drug Enforcement Agency (DEA) as Schedule I, II or III Controlled Substances.

Prescription morphine is manufactured in liquid, capsule, tablet, suppository, and injectable forms and sold under brand names that include MS Contin, Kadian, MSIR, Oramorph SR, and Roxanol. Morphine abusers may crush, chew, snort, or inject extended-release forms of morphine, thus releasing too much of the drug in too short a time, sometimes precipitating morphine overdose.

While useful to treat legitimate pain, morphine may cause physical dependence and addiction. The 2017 National Survey on Drug Use and Health (NSDUH) estimates that 3.2 million people in America currently misused prescription opiate painkillers in the past month. Of the estimated 11.1 million people who misused these prescription painkillers in the past year, 501,000 misused morphine.

DEPENDENCE -VS- ADDICTION

The National Institute on Drug Abuse (NIDA) says that different brain pathways are responsible for addiction and dependence on opiates (such as morphine and other painkilling drugs) and heroin. The reward pathway is involved in morphine addiction, while the brainstem and thalamus underlie morphine dependence. Since the brain areas are different, it is possible to be dependent on morphine without being addicted to it. However, addicted persons are most likely to be dependent on the narcotic as well.

MORPHINE DEPENDENCE

Taking prescription morphine as directed by a physician to relieve pain is not without consequences. You can become physically dependent on the drug, developing a tolerance to it and requiring more of it to relieve pain, without becoming psychologically addicted.

Morphine Tolerance

Using morphine for pain, even when you take it as your doctor prescribes, can result in you developing a tolerance for it. Your doctor may have even cautioned you that tolerance can set in within a few doses, and it’s a likely reason for careful physician monitoring. The NIDA defines tolerance as a state in which the person no longer responds to the drug, and a higher dose is required to achieve the same effect.

Signs that you have developed or are developing morphine tolerance are that you take higher doses than your doctor prescribed, and you take it more often. Recreational users of morphine have become tolerant of the narcotic drug when they have to take higher morphine doses to achieve the euphoric rush or high they’re after from this prescription painkiller.

MORPHINE ABUSE AND ADDICTION

When taking morphine for reasons other than pain, or taking it for pain but taking it other than prescribed, taking it more often, taking others’ prescriptions, morphine use crosses into the area of addiction. This can happen very quickly, in some instances as little as two weeks. That’s when the craving for more morphine sets in, driving the user to increase morphine use, either in dosage or frequency or both.

Why some people become addicted and others don’t involve a number of factors, including the person’s environment and personality. High levels of stress, having undergone childhood trauma, abuse or neglect can play a role in morphine addiction. Genetic factors are also thought to be a contributing factor in addiction. Furthermore, having a pre-existing mental health problem, such as depression or anxiety, can greatly exacerbate the tendency toward addiction.

The most common reason for misuse of pain relievers is to relieve physical pain (62.5 percent). According to the 2017 NSDUH, misuse is defined as “use without a prescription of one’s own or use at a higher dosage or more often than prescribed are both classified as misuse – even if it was for the purpose of pain relief.”

The 2017 NSDUH said that other reasons for pain reliever misuse included:

To feel good or get high – 13.2 percent
Relax or relieve tension – 8.4 percent
Help with sleep – 5.4 percent
Help with feelings or emotions – 3.6 percent
Experiment or see what it’s like – 2.8 percent
Hooked or have to have the drug – 2.2 percent
Some other reason – 1.0 percent
To increase (or decrease) the effects of other drugs – 0.7 percent

Substance use disorders (SUDs), according to the 2017 NSDUH, are characterized by “clinically significant impairment caused by the current use of alcohol or drugs (or both), including health problems, disability, and failure to meet major responsibilities at work, school or home.” Pain reliever use disorder, a type of SUD or addiction, involves clinically significant impairment caused by the recurrent use of pain relievers, resulting in persistent or increasing use, physical withdrawal, failure to meet responsibilities at home, school and work, and health problems. In 2017, an estimated 1.7 million people had a pain relief disorder.

Morphine Withdrawal Effects

When you have a morphine addiction, and the drug is not available, or you attempt to discontinue use on your own, withdrawal effects begin to set in within 6 to 12 hours after you last use the drug. Symptoms of morphine withdrawal include:

Anxiety
Body aches
Chills
Cravings (strong)
Depression (severe)
Diarrhea
Insomnia
Irritability
Muscle cramps
Muscle twitches
Nausea
Restlessness
Sweating
Vomiting

During active morphine withdrawal, you’re not thinking rationally and making the right decisions is difficult. All you can think about is getting and taking more morphine to stave off the withdrawal symptoms. This is a loss of control and is symptomatic of the endless cycle of addiction: using, coming down, thinking about using, getting drugs and using again.

If you’ve been taking morphine along with other psychotherapeutic drugs, or benzodiazepines, stimulants or other drugs, and alcohol, attempting to stop using on your own can be dangerous, even life-threatening. Abrupt cessation of morphine and other narcotic drugs, including illicit drugs, causes slowed breathing, which may result in unconsciousness, cardiac arrest, breathing that stops completely, coma and death. The only safe way to overcome morphine addiction and detox from the drug is through a supervised medical detox and subsequent drug addiction treatment.

For more about morphine dependence, addiction and recovery, check out these articles:

Sources:

Drug Enforcement Administration. “Controlled Substances: Alphabetical Order.” “Morphine.” Retrieved from https://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf

National Institute on Drug Abuse. “The Neurobiology of Drug Addiction.” “6: Definition of tolerance.” Retrieved from https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/6-definition-tolerance

National Institute on Drug Abuse. “The Neurobiology of Drug Addiction.” “8: Definition of dependence.” Retrieved from https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/8-definition-dependence

National Institute on Drug Abuse. “The Neurobiology of Drug Addiction.” “9: Brain regions mediating the development of morphine dependence.” Retrieved from https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/9-brain-regions-mediating-develo

National Institute on Drug Abuse. “The Neurobiology of Drug Addiction.” “10: Addiction vs dependence.” Retrieved from https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/10-addiction-vs-dependence

Substance Abuse and Mental Health Services Administration. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.” “Misuse of Psychotherapeutic Drugs.” “Pain Reliever Misuse.” Retrieved from https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report

Substance Abuse and Mental Health Services Administration. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.” “Opioid Misuse in the Past Year.” “Past Year Pain Reliever Misuse.” Retrieved from https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report

Substance Abuse and Mental Health Services Administration. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.” “Opioid Misuse in the Past Year.” “Past Year Pain Reliever Misuse.” “Main Reasons for the Last Misuse of Pain Relievers.” Retrieved from https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report

Substance Abuse and Mental Health Services Administration. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.” “Substance Use Disorders in the Past Year.” “Pain Reliever Use Disorder.” Retrieved from https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report